Psych exam 2

  1. What are the five categories of personalities traits?
    • Openness
    • Conscientiousness
    • Extraversion
    • Agreeableness
    • Neuroticism
  2. What factors have the greatest influence on personality?
  3. What are some elements of environment that are principal factors in influencing behavior and personality?
    • Heredity
    • Culture
    • Birth order
    • Parents
  4. Attachment theory:
    If an infant does not have stable, consistent meeting of needs, they will grow up to develop insecure attachment
  5. Personality disorders:
    An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment in functioning
  6. How is personality disorder manifested?
    • Two or more of the following areas:
    • 1. Cognition (perceptions and interpretations of others, events and self)
    • 2. Affectively (emotional intensity, range, appropriateness and lability)
    • 3. Interpersonal functioning
    • 4. Impulse control
  7. What comorbidity do personality disorders have?
    Axis I, Substance abuse and thymic disorders
  8. What are four key features of personality disorders?
    • Impairment of social, emotional and occupational functioning.
    • Individual exhibits a lack of insight into their own behavior.
    • Exhibits a variety of fixed defense mechanisms in their daily behavior.
    • Prognosis depends on insight, motivation to change and quality/consistency of therapy
  9. Three clusters of personality disorders:
    • Cluster A: odd, eccentric.
    • Cluster B: dramatic, emotional.
    • Cluster C: anxious, fearful, controlling
  10. Types of Cluster A personality disorders:
    • Paranoid
    • Schizoid
    • Schizotypal
  11. Types of Cluster B personality disorders:
    • Antisocial
    • Borderline
    • Histrionic
    • Narcissistic
  12. Types of Cluster C personality disorders:
    • Avoidant
    • Dependent
    • Obsessive-Compulsive
  13. Personality disorder that is more common in males, presents in childhood/adolscence and is characterized by solitariness, poor peer relationshipos, underachievement in school and subject of teasing (seen as eccentric).
    Cluster A
  14. What familial pattern can be seen in Cluster A Personality Disorder?
    Schizophrenia and delusional disorders
  15. Personality disorder that is characterized by suspicious, mistrustful of others
    • always ‘on guard’, tend to hold grudges and may have problems working with others, unable to form intimate relationships, usually either aloof and removed or angry and aggressive.
    • Paranoid personality disorder.
  16. Characterized by extreme difficulty relating to others, lack social/close relationships, very isolated, and loners with little emotions.
    Schizoid personality disorder
  17. Characterized by odd and peculiar speech and appearance, inappropriate affect, strange, unsupported beliefs, sometimes appears to be a milder form of schizophrenia.
    Schizoid Personality Disorder
  18. Cluster A Interventions:
    • Attempt to establish trust (may take years)
    • Establish rapport with family member
    • Be honest, open (not too warm)
    • Ignore or gently confronted odd beliefs or behaviors
    • Suggest cognitive-behavior therapy to enhance social skills
  19. Personality disorder cluster that is seen most in clinical setting:
    Cluster B
  20. Cluster B that is more common in males:
  21. Characterized by poor emotional regulation, intense unstable interpersonal relationships, manipulative, fear of abandonment, poor ego boundaries, poor sense of self, love-hate relationships, cognitive distortions, self-mutilating, suicide attempts and substance abuse.
    Borderline personality disorder
  22. Characterized by attention seeking behavior, excessive, shallow and rapidly changing feelings, need to be noticed and liked, compensate for feelings of insecurity, inadequacy and low self-esteem.
    Histrionic personality disorder
  23. Characterized by extreme arrogance, entitlement, self important, overwhelming need to be admired and have high status to make up for low self-esteem, using and manipulating others with not regard for others feelings.
    Narcissistic personality disorder
  24. DSM-IV TR criteria for diagnosis of antisocial personality disorder:
    • Requires three of the following:
    • Failure to conform to social norms
    • Consistent deceitfulness
    • Impulsivity/failure to plan
    • Irritability/aggressiveness
    • Consistent disregard for work/family obligations
    • Consistent disregard for safety of oneself and others
    • Lack of regret/remorse
  25. Characterized by emotional shallowness, possibly violent acts, substance abusers beginning early in life, no concern for and frequent violation of the rights of others, engage in illegal/irresponsible behavior with no remorse, possibly physically and emotionally dangerous.
    Antisocial personality disorder
  26. Definition of psychopath:
    Real psychopath has all criteria for antisocial personality disorder plus lack of remorse/empathy.
  27. Biological abnormalities in brain function in antisocial personality disorder:
    • Diminished stress response
    • Weak startle reflex in response to distress cues
    • Not as sensitive to the emotional connotations of language
    • Difficulty recognizing facial expressions of anger, fright, disgust
  28. Behaviors requiring intervention for antisocial personality disorder:
    • Exploitation and manipulation of others for personal gain
    • Belligerent and argumentative
    • Lacks remorse
    • Inability to delay gratification
  29. What is the violent triad?
    • Cruelty to animals
    • Enuresis
    • Firestarting
  30. Characterized by extreme anxiety and fear in social settings/relationships, sensitivy to rejection and criticism, shy, self-conscious, akward, desire intimacy but avoid others for fear of rejection, seldom tries something new or takes risks.
    Avoidant Personality Disorder
  31. Characterized by total reliance on others for support and decision-making, inability to function without spouse, partner, or family member, will do anything to avoid conflict and risk losing significant other, may choose abusive relationships rather than be alone.
    Dependent Personality Disorder
  32. Characterized by extremely rigid, controlling and stubborn, perfectionist, overly organized with extreme attention to detail and neatness, black and white thinking, controlling of others as well as self, over-reliance on rules and order, their way is the “right way.”
    Obsessive-Compulsive Personality Disorder
  33. Pharmacological treatment for patients with borderline personality disorder.
    SSRI and/or an antipsychotic.
  34. Pharmacological treatment for schizotypal personality disorder.
    Antipsychotics – may reduce paranoia, odd communication and ideas of reference
  35. What is chronic sorrow?
    Grief associated with ongoing loss such as chronic mental or physical illness.
  36. What makes grief different from major depression?
    Grieving person does not have poor self-attitude, worthlessness, guilt, etc…
  37. Symptoms of complicated bereavement.
    • Excessive hostility and bitterness
    • Prolonged emptiness and numbness
    • Inability to weep or express emotion
    • Failure to resume activities, work, go on with their lives
  38. What is mood?
    Pervasive and sustained emotion that colors one’s perspective of the world and how one functions in it.
  39. Three types of mood disorders.
    • Majore Depressive Disorder
    • Dysthymic disorder
    • Bipolar Disorder
  40. DWM-IV requirements for diagnosis of MDD.
    • At least 4 of the following with two weeks of depressed, sad mood and or loss of interest and pleasure:
    • Appetite/weight change
    • Sleep disturbance
    • Psychomotor agitation or retardation
    • Fatigue/low energy
    • Guilt or unworthiness
    • Poor concentration or indecisiveness
    • Recurrent thoughts of death, suicidal ideation
  41. What is early morning awakening?
    Classic sign of depression where person wakes and can’t get back to sleep and they ruminate.
  42. What feature of depression will push a person to the point of suicide?
  43. What are some cognitive features of depression?
    • Ambivalence
    • Inability to concentrate
    • Indecisiveness
    • Cognitive distortions
    • Impaired memory
  44. Some behaviors associated with depression?
    • Aggressiveness/agitation
    • Alcohol/drug abuse
    • Altered activity level
    • Over-dependency
    • Poor hygiene
    • Underachievement
  45. Ratio of depression between men and women.
    Women:Men, 2:1
  46. Risk factors for depression.
    • Prior episode
    • Family history
    • Prior suicide attempt
    • Female
    • Postpartum
    • Medical comorbidity
    • Lack of social support
    • Life stressors
    • History of neglect/sexual abuse
    • Current substance abuse
  47. Neurobiological cause of depression
    • Decrease of norepinephrine and serotonin in synapse
    • Overactivation of HPA axis
  48. Vegattive signs of depression
    • Decrease sleep
    • Decrease apetitie
    • Poor energy
  49. Labs used to help diagnose depression.
    • TSH
    • T3
    • T4
    • CBC
  50. What type of depression is situational but doesn’t meet the criteria for major depression?
    Adjustment disorder
  51. What psychotic features are usually related to major depression?
    Mood congruent delusions (usually gloomy)
  52. MDD – postpartum onset
    Within 4 weeks of delivery
  53. Signs that mother may be experiencing PPD?
    • Poor maternal-child bonding
    • Avoiding infant
    • Thoughts of harming infant
  54. Risk factors for PPD?
    • Sleep deprivation
    • Hormonal shifts
  55. What side effects are the elderly more sensitive to in antidepressants?
    Anticholinergic side effects
  56. Causes of seasonal affective disorder:
    • Less daylight durin fall/winter
    • Too much melatonin
  57. What makes SAD different from major depression?
    Oversleeping and increased appetite for carbohydrates
  58. Treatments for SAD?
    • Time spent outdoors
    • Medications (SSRI’s)
    • Light therapy
  59. What is dysthymic disorder?
    Mild but chronic form of depression for at least two years. Often begins in childhood.
  60. When is ECT considered to treat depression?
    • If pharmacologic treatment fails of is not safe
    • When rapid response is needed for severe depression
    • Treatment of psychotic depression
  61. Three MAOIs:
    • Phenelzine (Nardil)
    • Tranylcypromine (Parnate)
    • Selegiline (Eldepryl, Atapryl)
  62. MAOI that is also used to treat parkinsonism.
  63. Time it may take for MAOIs to take effect.
    3 – 6 weeks
  64. Most frequent adverse effects of MAOIs:
    • Orthostatic hypotension
    • Insomnia
    • Weight gain
    • Edema
    • Sexual dysfunction
  65. Rare side effect of MAOIs:
    Tyramine-induced hypertensive crisis.
  66. Seven common tricyclic antidepressants:
    • Elavil (amitriptyline)
    • Norpramin (desipramine)
    • Pamelor (nortryptyline)
    • Pertofrane (desipramine)
    • Sinequan (doxepin)
    • Tofranil (imipramine)
    • Anafranil (clomipramine)
  67. Which tricyclic antidepressant is used for OCD?
  68. Uses of tricyclic antidepressants.
    • Depression
    • Anxiety disorders
    • OCD
    • Chronic pain
    • Sleep Disorders
  69. Time it may take for TCAs to reach therapeutic effect:
    3 – 4 weeks
  70. Adverse effects of TCAs:
    • Anticholinergic (dry mouth, blurred vision, constipation, memory)
    • Antiadreneregic (orthostatic hypotension)
    • Antihistaminergic (sedation, weight gain)
    • Cardiac
  71. Six common SSRIs:
    • Fluoxetine (Prozac)
    • Fluvoxamine (Luvox)
    • Paroxetine (Paxil)
    • Sertraline (Zoloft)
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)
  72. Uses for SSRIs:
    • Depression
    • OCD
    • Panic disorder
    • Social anxiety disorder
    • PTSD
    • Eating disorders
    • Borderline personality disorder
  73. Time it may take for SSRIs to take effect:
    • 3 – 6 weeks for depression
    • 12 – 16 weeks for OCD
  74. Two problems that need observation with SSRIs:
    • Activation of bipolar disorder
    • Suicidal Ideation
  75. Common adverse effects with SSRIs:
    • Anxiety
    • Agitation
    • Akathisia
    • Insomnia
    • Nausea
    • Diarrhea
    • Sexual dysfunction
  76. Signs of serotonin syndrome:
    • Diarrhea
    • Restlessness
    • Extreme agitation
    • Hyperreflexia and autonomic instability
    • Myoclonus
    • Seizures
    • Hyperthermia
    • Rigidity
    • Delirium
    • Coma
    • Possible death
  77. Symptoms of serotonin discontinuation syndrome:
    • Agitation
    • Nausea
    • Disequilibrium
    • Dysphoria
  78. Agent used to combat sexual dysfunction with SSRIs:
  79. Four types of novel agents for the management of depression:
    • Serotonin-2 antagonist/reuptake inhibitors
    • Serotonin/norepinephrine reuptake inhibitors (SNRIs)
    • Norepinephrine dopamine reuptake inhibitor (NDRI)
    • Alpha 2 antagonist/noradrenaline and specific serotonergic agent (NaSSA)
  80. Examples of Serotonin-2 antagonist reuptake inhibitors:
    • Hephazodone (Serzone)
    • Trazodone (Desyrel)
  81. Examples of SNRIs:
    • Venlafaxine (Effexor)
    • Duloxatine (Cymbalta)
  82. Example of NDRI:
    Bupropion (Wellbutrin, Zyban)
  83. Example of NaSSA:
    Mirtazepine (Remeron)
  84. How is Bipolar I defined:
    1 or more manic episodes
  85. How is Bipolar II defined:
    Recurrent major depressive episodes with hypomanic episodes
  86. How is hypomania defined:
    • Expansive mood for at least 4 days which is clearly different from the non-depressed mood, with 3 or more of the following:
    • Decreased need for sleep
    • Inflated self esteem or grandiosity
    • Flight of ideas or racing thoughts
    • Increased goal directed activity
    • More talkative, may have rapid rate
    • Excessive involvement in pleasurable activities that may have negative consequences
    • Distractibility
  87. How is Mania defined:
    • Expansive, hostile or elated mood which persists for at least 1 week with presence of 3 or more of the following symptoms:
    • Inflated self esteem or grandiosity
    • Decreased need for sleep
    • More talkative, rapid or pressured speech
    • Flight of ideas, racing thoughts
    • Distractibility
    • Increased goal directed activity
    • Excessive involvement in pleasurable, potentially dangerous activities
    • May have psychotic symptoms
  88. Behaviors associated with Mania:
    • Resistance to treatment
    • Disorganized thinking and bizarre behavior
    • Psychotic features, primarily delusions
    • Alteration in mode of dress/appearance
    • Impulsive high-risk behavior
    • Pacing/hyperactive
  89. Elements of nursing care for bipolar disorder.
    • Sleep hygiene
    • Low stress
    • Medication
    • Exercise and nutrition
    • Mood chart
    • Avoid alcohol/drugs
  90. Pharmacological treatment for Bipolar:
    • Lithium carbonate –GOLD STANDARD
    • Anticonvulsants
    • Antipsychotics
  91. Three anticonvulsants used to treat Bipolar:
    • Valproic acid (Depakote) – MOST OFTEN USED
    • Carbamazepine (Tegretol) – INTERACTS OFTEN WITH OTHER MEDS
  92. Five antipsychotics used to treat Bipolar:
    • Resperidone
    • Apripizole
    • Quetiapine
    • Olanzepine
    • Ziprasidone
  93. Goals of treatment of bipolar during acute/initiation phase:
    • Control symptoms of agitation, aggression and impulsivity
    • Return to usual levels of psychosocial functioning
    • Avoid precipitation of manic episode
  94. Treatment for bipolar disorder during acute/initiation phase:
    • Severe mania/mixed episode: lithium or valproate with antipsychotic
    • Less severe: monotherapy with lithium, valproate, atypical antipsychotic
  95. Goals of treatment of bipolar during stabilization and maintenance phase:
    • Prevent relapse and recurrence
    • Reduce subthreshold symptoms
    • Reduce suicide risk
    • Reduce cycling frequency or milder degrees of mood instability
    • Improve overall function
  96. Baseline test before starting lithium.
    • BUN/Creatinine
    • Thyroid
    • ECG
    • Pregnancy
  97. Medication treatment of bipolar in children/adolescents:
    Acute mania: Lithium or Depakote and Risperidone or Abilify
  98. Serum blood levels of Lithium during acute episode:
    0.8 – 1.2 mEq per Liter
  99. Serum blood levels of Lithium during maintenance:
    0.4 – 1.0 mEq per liter
  100. Side effects of lithium:
    • Polyuria/polydipsia
    • Weight gain
    • Hair loss
    • Acne
    • Cognitive dullness
    • Indigestion
    • Hypothyroidism
    • Renal insufficiency
  101. Toxic lithium level:
    >1.5 mEq/L
  102. Early signs of lithium toxicity:
    • Coarse hand tremor
    • Severe GI upset
    • Blurred vision
    • Vertigo
    • Ataxia
  103. Late signs of lithium toxicity:
    • Seizures
    • Coma
    • Dysrhythmias
    • Permanent
    • Neurological impairment
  104. Management of lithium toxicity:
    • History of Incident
    • Vitals, LOC
    • Lithium levels, electrolytes, EKG
    • Hydration: 5-6 liters
    • Adequate NaCl intake
    • Dialysis (if severe)
  105. May prevent lithium toxicity:
    • Take with meals to decrease GI irritation
    • Drink 8-10 glasses of water/day
    • Avoid OTC’s unless provider okays
    • Avoid NSAIDS
    • Avoid caffeine
  106. Common transient adverse effects of anticonvulsants:
    • Nausea
    • Diarrhea
    • Sedation
  107. Common maintained adverse effects of anticonvulsants:
    • Weight gain
    • Tremor
    • Increased risk for thrombocytopenia
    • Risk for agranulocytosis
  108. Two anticonvulsant mood stabilizers:
    • Lamotrigine (Lamictal)
    • Topiramate (Topopmax)
  109. Anticonvulsants used for treating acute mania:
    • Valproate/Divalproex (Depakene/Depakote)
    • Carbamazepine (Tegretol)
  110. Used to treat anxiety and pain associated with depression:
    Gabapentin (Neurontin)
  111. Anticonvulsant that may cause polycystic ovarian disease in women:
  112. Antipsychotics used to manageme Bipolar Disorder:
    • Olanzepine (Zyprexa)
    • Quetiapine (Seroquel)
    • Ziprasidone (Geodon)
    • Risperidone
    • Abilify
  113. Typical side effects of antipsychotics:
    • Hyperglycemia
    • Decreased insulin sensitivity
    • Hyperlipidemia
    • Weight gain
  114. Adverse Effects of Antipsychotics:
    • liver toxicity
    • Sedation
    • Hypotension
    • EPS
    • Seizures
    • Anticholinergic effects
    • Weight gain
    • Neuroleptic malignant syndrome
    • Increased prolactin (resperidone)
  115. Rare side effect of MAOIs.
    Tyramine induced hypertensive crisis.
  116. Most sedating of Tricyclic Antidepressants.
  117. Alternative use for Tricyclic antidepressants.
    Neurogenic pain, phantom limb.
  118. Tricyclic used for enuresis.
    Tofranil (imipramine)
  119. Tricyclic used for OCD.
    Anafanil (clomipramine)
  120. Common adverse effects of tricyclics that result in avoiding usage in the elderly.
    Anticholinergic effects, cardiac and antiadrenergic (ortho hypo)
  121. Medication to avoid when patient is suicidal.
    Elavil (commonly used to overdose)
  122. Common response to stopping usage of SSRIs.
    Discontinuation syndrome
  123. Uses for SSRIs.
    • Depression
    • Anxiety disorder
    • PTSD
    • Eating disorder
    • Borderline personality disorder
    • OCD
  124. What to look for when SSRI is given to bipolar disorder.
    Hypomanic state
  125. Antidepressant that has the lowest incidence of sexual side effects.
  126. Symptoms of serotonin syndrom.
    • Diarrhea
    • Restlessness
    • Extremem agitation
    • Hyperreflexia
    • Myoclonus
    • Seizures
    • Hyperthermia
    • Rigidity
    • Delirium
    • Coma
    • Possibly death
  127. S2RI that is so sedating that it is not used for depression.
    • Trazadone (Desyrel)
    • Used for insomnia
  128. SNRI that may have good effects on children/adolescents.
    Venlafaxine (Effexor)
  129. SNRI that is used to treat pain/neurogenic pain.
    Duloxatine (Cymbalta)
  130. Used for smoking cessation and sometimes adolescent ADHD in low doses.
    Bupropion (Wellbutrin; Zyban)
  131. Alpha 2 antagonist / noradrenaline and specific serotonergic agent (NaSSA).
    • Mirtazepine (Remeron)
    • Very sedating and causes weight gain
  132. Symptoms of mild anxiety.
    Alert and perceptual field is increased. Increased motivation and learning.
  133. Symptoms of moderate anxiety.
    Focuses only on immediate concern perceptual field narrows.
  134. Symptoms of severe anxiety.
    Focuses of specific detail only and unaware of surroundings. Tunnel vision.
  135. Symptoms of panic.
    Loss of control, dissociation, shock, dread, terror.
  136. Neurotransmitters involved in suppressing the fear circuit.
    • Serotonin
    • GABA
  137. How medications for anxiety work.
    • SSRIs-increase serotonin
    • Benzos – increase GABA
  138. Percentage of Americans with anxiety disorder.
  139. Medical problems that mimic anxiety.
    • Encocrine/hypothyroidism
    • COPD, impending PE
    • MI, CHF
    • Cocaine use
    • Benzo withdrawal
  140. What are people with anxiety disorders more likely to develop?
  141. Definition of Panick Attack?
    • Discreet episode of intense fear/discomfot with at least 4 of the following symptoms which develop abruptly and reach a peak within 10 minutes.
    • Palpitations
    • Sweating
    • Trembling
    • SOB
    • Choking feeling
    • Chest pain
    • Nausea
    • Dizziness
    • De-realization/depersonalization
    • Fear of losing control
    • Paresthesias
    • Chills/hot flashes
  142. Definition of Panic Disorder
    • Recurrent unexpected panic attacks and at least one of the attacks has been followed by at least 1 month or more of the following.
    • 1. Persistent concern about having additional attacks
    • 2. Worry about the implications of the attack or its consequences
    • 3. A significant change in behavior related to attacks
  143. Social Phobia
    • Fear of scrutiny and judgment.
    • Worry about being embarrassed
    • Performance anxiety
  144. Physical symptoms of social phobia
    • Blushing
    • Stammering
    • Sweating
    • Upset stomach
    • Racing heart
    • Complete panic
  145. Diagnostic criteria for OCD.
    • •Recurrent, persistent, inappropriate thoughts that result in anxiety or distress
    • •Person attempts to neutralize with some other thought or action or suppress/ignore symptoms
    • •Person recognizes that the thoughts are their own, unreasonable, excessive
    • •Patient is likely to conceal symptoms
    • •Rigid adherence to rules, behavior patterns that decrease anxiety
    • •Obsessions or compulsions consumer greater than 1 hour per day
  146. Diagnostic criteria for PTSD.
    • •An acute acquired mental disorder that can occur soon after trauma or can have a delayed onset of more than 6 months after the trauma
    • •Referred to as Acute Stress Disorder when symptomatic during the first 4 weeks after the trauma- may not nesc progress to PTSD
    • •The associated trauma must be an event that is outside the range of normal human experience and would be seriously disturbing to anyone.
    • •Helplessness and horror contribute to the development of PTSD
  147. Symptoms of PTSD.
    • Flashbacks
    • Generalized anxiety-sympathetic nervous system stays aroused
    • Emotional numbness, avoidance of places/images
    • Nightmares, hypervigilance, increase startle
    • Angry outbursts, irritability, aggression
  148. Treatments for PTSD.
    • CBT: trauma focused
    • SSRIs
    • Family support/education
    • Watch for drug alcohol abuse
    • Watch for suicide risk
  149. Medication treatment for PTSD.
    • SSRIs
    • Benzodiazepines
  150. First line treatment for chronic anxiety symptoms.
  151. Medication used short-term for acute anxiety and agitation
  152. Benzo used for ETOH withdrawal.
    • Ativan
    • Sometimes valium
  153. Non-benzo management of anxiety.
    BuSpar (serotonin partial-agonist)
  154. Used to treat performance anxiety.
    Propranolol (Inderal) – beta blocker
  155. Most frequent method of suicide.
  156. Eight factors found critical in assessing suicide risk.
    • Medical seriousness of previous attempts
    • History of suicide attempts
    • Acute suicidal ideation
    • Severe hopelessness
    • Attraction to death
    • Family history of suicde
    • Acute overuse of alcohol
    • Loss/separations
  157. Possible warning signs of suicide.
    • Talking about dying
    • Recent loss
    • Change in personality
    • Change in behavior
    • Change in sleep patterns
    • Change in eating habits
    • Diminished sexual interest
    • Fear of losing control
    • Low self esteem
    • No hope for the future
  158. Questions that may be helpful in assessing suicide risk.
    • 1.Have you had any moments when you felt like giving up?
    • 2.Wished you were dead?
    • 3.Have you considered taking your own life?
    • 4.If yes, do you have a plan?
    • 5.If yes, do you have a weapon?
    • 6.If yes, where is it?
    • 7.How often have you been thinking about taking your life?
Card Set
Psych exam 2
personality disorder, major depression, anxiety, mood disorder, suicide